A current health care delivery model for elderly patients in rural communities is nonexistent. As a result, primary care physicians are unable to handle the increasing numbers of retiring baby boomers in these rural communities. While telehealth and telemedicine implemented by a nurse-centric model has been used to address this problem, these efforts have failed to show a significant reduction in hospital readmissions or overall healthcare costs.
For example, in 2012, Intel and the Mayo Clinic jointly performed an extensive study of the effectiveness of a nurse-centric model used in conjunction with remote telehealth/telemedicine monitoring (“RTM”). A randomized controlled trial was performed among adults aged older than 60 years at high risk for rehospitalization. Participants were randomized to RTM (with daily input) or to patient-driven usual care. RTM was accomplished by daily biometrics, symptom reporting, and videoconference. Among older patients at the end of the study, RTM with a nurse-centric model did not result in fewer hospitalizations or emergency room (“ER”) visits.
The basic premise of the physician-centric health care delivery system used in conjunction with RTM, as opposed to a nurse-centric system used in conjunction with RTM, is that physicians can dramatically reduce ER and hospital admissions/readmissions better than nurses, especially when the health care is provided in a home care or nursing home care setting. There are two practical reasons for this. First, in a nurse-centric system used in conjunction with RTM, because of the liability, a patient recently discharged from a hospital frequently will be unnecessarily sent back to an ER by a nurse after analyzing the RTM data. Further, the nurse analyzing the data may not know the patient's medical history as thoroughly as a physician who has access to the patient's electronic health record (“EHR”). Yet further, because a nurse cannot readily order lab tests or prescribe medications, and typically does not carry individual malpractice insurance, a nurse may not be willing to assume the liability risk for erroneously opting for home treatment rather than hospitalization. On the other hand, a trained physician can more readily assess the symptoms presented by the data, order lab tests and a chest x-ray if needed (or perhaps simply modify medications), thereby saving the costs relating to an ER visit, or hospital admission or readmission. Moreover, in the event that hospital admission is warranted, the physician can admit the patient directly to the hospital whereas, typically, a nurse does not have admitting rights and would have to, instead, redirect the patient to the ER for hospital admission.
Secondly, a physician may be afforded a better opportunity to offer to a patient the hospice alternative to hospital admission. Patients with late-term illnesses may often bounce between hospital discharge and hospital readmission on a weekly cycle. A physician with influence over the patient's medical power of attorney may be able to offer patients the hospice alternative at the appropriate time to break this cycle and lessen the cost of repeated hospitalization.
Several cost benefits of a physician-centric model used in conjunction with RTM are apparent. Once a patient appears in the ER without a prior diagnosis by a treating physician, the risk imposed on an ER physician for prematurely discharging the patient from the hospital may cause patients to be unnecessarily admitted instead. Once admitted, unnecessary costs of additional tests performed by the hospital may be incurred. If these visits to the ER can be reduced by the intervention of a treating physician using RTM, the costs relating to the admission and tests may be avoided. In addition, in a physician-centric model used in conjunction with RTM in accordance with the invention, the treating physician is available 24/7, as needed. This means that the treating physician can analyze patient data and interpret test results close to real-time and therefore can administer patient care quickly, thereby reducing the urgency of a patient to appear in the ER for treatment.
Thus, there is a need for a physician-centric health care delivery system for patients, particularly elderly patients in rural communities, which implements state-of-the-art technologies in telemedicine. This system may be combined with personal care visits by a member of a house call physicians network or patient visits to a satellite/mobile facility such as, for example, a free standing medical clinic, an office building, a room in an office or a kiosk, to further reduce readmissions and health care costs. This system incorporates a physician-based clinical decision support system (“PCDSS”) integrated with a remote telehealth/telemedicine monitoring (RTM) platform that is capable of analyzing and diagnosing the medical condition of a patient and/or administering health care to a patient in real-time while also providing the treating physician with recommended treatment options. In a further embodiment, the physician-centric health care delivery system includes a “smart” delivery device capable of automatically administering medications to a wearer of the device. The “smart” delivery device may be further adapted to communicate remotely with a physician so that the physician can modify the amount or type of drug being delivered. The present invention addresses these and other needs.